Living for 18 years in my childhood home had a significant impact on my mental health including an overwhelming sense of anxiety and damaged sense of self. In this chapter we will explore how my ACEs led me to acquire mental health problems as a child that continued into my young adult life.
The two most common mental health disorders of individuals who have been impacted by high ACE scores are anxiety and depression. I developed anxiety because I was constantly living in a fight, flight, or freeze mode, unsure of when the next physical or verbal blow would come. When the blow did come my way, I could not fully escape. When it was a physical attack, I would try to outsmart my parent by dodging and evading them and putting large objects, like a bed or table, between us. However, the thrown object, hand, or belt would eventually reach me. When I was verbally attacked I had two options: retort back with an equally hateful comment or freeze and swallow back tears so I wouldn’t be seen as weak.
When I have told my story in the past, some people have asked me why I did not escape my home and run away? My answer is, I tried many, many times. Sometimes when I was sent to my room after an altercation with my parent, I would try to climb out of my second story bedroom window. I would remove the window screen and quietly place it to the side. Then I would poke my head out the window to confirm no one would see me. My bedroom window was next to another window that you could see when going up the stairs to the second floor. After confirming the coast was clear, I would throw my leg out and straddle the window sill. I remember gazing down at the brick wall which I had meticulously planned to scale down to safety. I had memorized which bricks were sticking out far enough for me to grab and hold my weight. However, I could never convince myself to move my second leg out the window. I had no where to go, and I was scared I would get in more trouble if I ran away. Therefore, after a couple minutes of debating with myself, I returned the screen and closed the window. Sitting on the floor, looking out, the world did not look like freedom, but like a trap that would just lead me into more misfortune.
As Dr. Van Der Kolk explained in his book, “after having been traumatized, people automatically keep repeating certain actions, emotions, and sensations related to the trauma” (The Body Keeps the Score, p.180). For me, this was the bases of me developing anxiety. The emotion of feeling trapped and outsmarted by the world prevented me from having trust that everything was going to work out. This led me to become worried about every little aspect in my life, no matter the true risk.
Dealing with anxiety meant that I was constantly in a mode where I felt that if I did not control every situation, something horrible would happen and I would be responsible for the consequences. Therefore, I strove to be prepared and three steps ahead of any possible major event. Whenever, I entered a new building or area, I planned how I would escape or fight off an assailant. Additionally, I frequently carried a first aid kid and other tools I hoped to use in emergencies. There were a couple times that this pre-planning was useful, and I was praised on how I reacted. However, this level of anxiety did not balance the benefit of helping others.
This feeling of anxiety was exasperated to unmanageable levels, especially when there was an immediate threat to my living situation. In these situations I struggled to focus on the knowledge that I would be safe and taken care of. Even though as a child I never ran out of food or became homeless, the fear of not having a home or food kept me in my toxic childhood home. When there was a financial stressor that might put my housing or basic living needs in jeopardy (which occurred a couple times during my undergraduate and graduate school) I began to become extremely anxious. I worried that if the stressor was not solved immediately, I would be forced to go back to live with my parents and re-live the entrapment of my childhood.
My anxiety remained with me all day and did not leave me when I closed my eyes to fall asleep. Whenever I had a big event the next day, I spent the night in a nightmare where everything went wrong. For example, in high school I organized an event where we had mini “ted-talk” style presentations all throughout the school where students would rotate through the day. The night before, I had a nightmare where the large 12 foot long paper calendar was ripped off the wall and trampled. Then the presenters did not arrive to give their talks, the teachers were upset at the wasted time, and my classmates ditched to pursue more interesting activities. After waking up the next morning drenched in sweat, I drove in earlier then planned to prevent my dream from occurring. First, I double taped the calendar and called the presenters to remind them of their presentations. Then, I went room to room to make sure all the teachers had what they needed, gave them individualized agendas, and thanked them for allowing the event to occur in their classroom.
Anxiety ruled my life, and I could not appreciate the fact that life happened and there are things that could not be planned for. I felt I had to have back up plans for every possibility. I believed that if I didn’t control my surroundings then something horrible would happen. I was constantly living in fight or flight mode. I knew that others would say behind my back I was a control-freak and bossy. However, I justified that they did not understand that if I did not triple check that the calendar poster was up properly, then everyone would become upset and blame me for creating such a disastrous event. I would become trapped, and would have no where to hide from the eternal hatred and disappointment. I would never be able to show my face at my high school again, and people would even remember the situation at our 10 year high school reunion. Of note, our high school reunion has yet to occur, so I have yet to find out if my classmates even remember that I organized that event.
As a child I was frequently told by my parent that I was the source for all the pain and unhappiness in our household. This mindset led me to believe I was the cause of others’ displeasure and negative emotional state. This decreased my self confidence and I developed a sense of self that I was unintelligent, a bad person, and not worthy of others’ love.
For many years I tried to be the best daughter, student, martial artist, etc, with the hope that my parents would be proud of me. But, it was never good enough. My parent always had a criticism on my work and a praise for someone else. I do not know what motivated me to keep trying to please them. Part of me hoped that one day I would make them so proud I would finally become the daughter they dreamed of. Even when I was accepted into multiple medical schools, I had the impression that it still wasn’t good enough and they were not faised by my accomplishment of becoming the first medical doctor in my family.
As I grew older, this inaccurate conception of my impact on others emotional state caused conflict in my relationships. For example, when my husband was not explicitly expressing a positive emotion, I feared that he was angry, and I was the cause of his frustration. In response, I practiced being brave enough to ask him to articulate which specific emotion he was feeling, and if I did something to cause that emotion. This was very helpful for both of us, and opened the door to a new realm of healthy communication strategy of expressing our emotions. However, even after he told me his emotion, a voice in the back of my mind speculated if he was telling the truth. I had to constantly remind myself that healing from ACEs is a life-long endeavor.
Worrying about other’s emotions and opinions of me also impacted my behavior. I become a people pleaser. In college I became a martyr, who put other peoples’ needs before my own. In one aspect, this personality trait led me to be a caring and empathic caregiver for the elderly during my college job. However, it also caused me to burn out quickly as I took on more than I could physically handle. For example, I frequently overworked myself to address all the wishes and needs of my patients. This led me to work over time. However, since I knew my boss would not approve the overtime I would not report the extra time. This bad habit led me not just to quickly burn out as a caregiver, but also place my self in an unhealthy situation where I promised more than could physically provide my patients. This resulted in unmet promises and disappointed patients. In fact, this became a negative feedback where I blamed myself for the unmet promises that I should have never been promising in the first place.
***Mental Health Diagnosis***
Even though I pursued a degree in psychology in college, I never took the time to self-diagnose or wonder if I struggled with a mental health condition. One of the first big fights my future husband, Jonah, and I had, was that he stated I was codependent in our relationship. This meant that I was excessively reliant on him for emotional and psychological support. Interestingly, this was the first time that I didn’t take a comment on my personality as a set trait. Instead, I saw it as an area for growth and a way to develop into the person that was worthy of his love. I began by reading a book by Melody Beattie, “Codependent No More: How to Stop Controlling Others and Start Caring for Yourself.” Then, after learning my college provided free therapy sessions, I began my first rounds of therapy. One of the therapists provided me a book by Cheri Huber titled “There Is Nothing Wrong With You: Going Beyond Self-Hate.” Reading this simple and to the point book led me to have more confusion than comfort. I was receiving conflicting messages. This book and therapist told me that I should be proud of who I was and should love myself for all my imperfections. However, my never ending list of negative personality traits and behaviors had led my family, friends, and peers to hate me. How in the world was I supposed to love myself when no one loved me? Didn’t this demonstrate that I was unworthy of love and compassion? In chapter 7, I will discuss more about how therapy helped me begin to accept that I was actually a good person who deeply cared about others, and strove to treat them with respect and love.
A couple years later in our medical school psychology unit I began to analyze the mental health disorders and contemplate if I had a disorder of anxiety. I brought my concern to my medical school therapist who provided me valuable insight and support. We discussed that since my anxiety transected all aspects of my life, I could be diagnosed with generalized anxiety disorder.
The most recent medical diagnosing literature is the DSM-5 and it is used both in medical and psychiatric practice for consensus in medical record keeping, insurance billing, and medication administration. The DSM-5 classifies generalized anxiety as under the disorder class of anxiety disorders. This disorder is defined as “excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).” Additionally, the individual must struggle to control the excessive worry. Lastly, all anxiety disorders must demonstrate three or more physical symptoms most days for the past 6 months. These symptoms include restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and sleep disturbances. The mental worry or symptoms must impair the individual in being able to function in significant aspects of their life, including while interacting socially or at work/school. Important to note, this anxiety is not due to another mental or physical health condition, substance of abuse, nor occurs only during a specific event or situation.
Unfortunately, I could check mark all of the qualifications except possibly irritability. At first, being officially diagnosed with gernalized anxiety disorder brought on more excessive worrying. I didn’t want to be labeled and put into a box, as is so often done with medical and mental health conditions. However, over time, I became more confident and proud of having a name to describe my feelings and behaviors. It also helped provide evidence to myself that I was not a “bad person” or “broken,” but was just struggling with a health condition. I became optimistic to learn how to manage the condition to become the type of person, wife, and physician I hoped to become.
***Escape through Suicide ***
I remembered the times I would lock myself in my bedroom (my parents had a key so it was never truly locked) and held one of our house phones tightly to my bounding heart. I tried to figure out who to call for help but I didn’t know who. I was too scared to dial 911 because I didn’t know where the police would take me. I knew that if I was put into foster care I might never be able to see my younger brother or friends again. This was the early 2000s, before anyone in my household had a cell phone. Therefore, all my parents had to do was pick up one of the other house phones and hear me talking on the other line. The parent would have burst into my room and whipped me with a belt or worse. Again I was trapped.
I thought about what would happen if I killed myself. I knew my parents would be furious, Not even death could prevent me from escaping my parent. No, no one could fight or protect me, but me!
Unfortunately, there is a 5,000 % increase in risk of suicide for an individuals who have ACE scores up to 6 points. Essentially my anxiety over my fear of abuse saved my life, as it is supposed to. Anxiety was there to protect me from getting hurt. I am very thankful I listened to that emotion because without it I would not be able to tell my story. No situation is forever, everything is temporary. An emotion of fear, pain, or entrapment is temporary. All that you need to do to overcome is to accept that the current emotion will pass as other emotions have in the past. Only then can one develop resilience, and begin to take control of their life. In the second half of the book I will explore how I used my traumatic childhood experiences and mental health diagnosis to explore healing and treatment.
***This Blog Post is for educational purposes only and is not intended nor implied to be a substitute for professional medical advice, diagnosis or treatment. This does not imply a doctor-patient relationship. All opinions are the opinions of the writer and not reflective of any institution or employer. Please follow up with your health provider and therapist for any additional questions or support.***